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Cholecystectomy in cardiothoracic organ transplant recipients
1Department of Surgery, St Vincent's Hospital, Sydney, NSW, Australia.
Insights
Gallstones are common in cardiothoracic transplant recipients, with symptomatic cases benefiting from cholecystectomy. Asymptomatic gallstones may not require surgery, warranting further study for optimal management.
Area of Science:
- Transplant Surgery
- Gastroenterology
- Organ Transplantation
Background:
- Gallstones (cholelithiasis) pose potential risks in patients undergoing cardiothoracic organ transplantation.
- Understanding these risks is crucial for managing post-transplant complications.
Purpose of the Study:
- To evaluate the risks of gallstones and cholecystectomy in cardiothoracic organ transplant recipients.
- To compare patients with gallstones to the general transplant population.
Main Methods:
- Retrospective medical record review of 645 cardiothoracic organ transplant recipients.
- Analysis of gallstone incidence (5.7%) and cholecystectomy rates (32 patients).
Main Results:
- Patients with gallstones were older, more likely female, and had higher BMI.
- Cholecystectomy was performed for symptomatic disease, with a median 5-month delay.
- Postoperative outcomes included one death, a median 3-day stay, and 4 patients with further biliary issues; asymptomatic cases remained stable.
Conclusions:
- Minilaparotomy or laparoscopic cholecystectomy is recommended for symptomatic gallstones in transplant recipients.
- Conservative management of asymptomatic gallstones showed favorable outcomes, suggesting it as a viable option.
Objectives:
To assess the risks associated with cholelithiasis and cholecystectomy in cardiothoracic organ transplant recipients at this hospital and to identify any differences with potential causal significance between the group with known gallstones and the transplant recipient group as a whole.
Design:
Medical records survey.
Setting:
Tertiary care university hospital.
Patients:
Six hundred forty-five patients had cardiothoracic organ transplantation at this hospital between February 1, 1984, and May 31, 1996. Gallstones were detected in 37 (5.7%) of these patients and 32 patients underwent cholecystectomy, of which 29 operations were performed primarily for symptomatic gallstone disease. All cholecystectomies were performed after transplantation.
Main Outcome Measures:
Mortality, morbidity, postoperative biliary disease.
Results:
Patients with gallstones were significantly older than the transplant patient group as a whole (Student t test, P=.001); they were more likely to be female (chi2 test, P=.05); and they had a higher body mass index (t test, P=.001). There were no significant differences in the maximum serum bilirubin level during the transplantation admission, incidence of diabetes mellitus, cholestyramine use, or cyclosporine dosage during the first 12 months after transplantation. Cholecystectomy was performed after a median 5-month symptomatic period, mostly by the minilaparotomy method. Forty-five percent of cholecystectomies were urgent or semi-urgent. One patient died of lung infection on the second postoperative day. The median postoperative stay was 3 days. At a median 33 months' follow-up, 4 patients have had further biliary problems (2 patients with common bile duct stones, 1 patient with intrahepatic stones, and 1 patient with biliary dyskinesia). Four other patients with asymptomatic gallstones who did not receive cholecystectomy have remained asymptomatic for between 15 and 67 months.
Conclusions:
Cholecystectomy by the minilaparotomy or laparoscopic methods, with routine operative cholangiography, is the preferred treatment for symptomatic gallstones in cardiothoracic organ transplant recipients. Although the optimum management of asymptomatic gallstones in these patients remains unclear, our favorable experience with a policy of reserving cholecystectomy for symptomatic cases seems noteworthy.